ABSTRACT Hypertension causes an estimated 395,000 deaths in the US each year: one out of every six deaths. Hypertension is second only to smoking as a modifiable cause of death in the US. Poor blood pressure (BP) control increases the risk of myocardial infarction, stroke and death and is often due to delays in treatment intensification. We have developed a telehealth service called Centralized Healthcare Solutions that has successfully delivered clinical pharmacy services remotely to private physician offices, especially in small medical offices and rural locations. In our prior work, we demonstrated that a physician-pharmacist collaboration could cost effectively reduce BP, but pharmacists spent a considerable proportion of their time obtaining and aggregating patients' home BP measurements. Thus, we have developed an additional m- health solution called What's your BP? (WyBP), a custom- built bi-directional SMS-based (short message service, or texting) platform. WyBP is inexpensive (i.e., does not require investment in smartphone technology, or WiFi), acceptable to a broad range of patients (including the elderly and rural populations), scalable to subject volume observed in busy clinical settings, and easily integrated into typical clinic workflows. In two pilots, we demonstrated a high rate of adherence, indicating that patients were willing and able to take home BP measurements and send them to our research team. This proposal combines our two prior efforts to use remotely located pharmacists and bi-directional texting to improve efficiencies, reduce cost and improve access to a dedicated pharmacist. A major gap in our knowledge is whether the potency of a ?virtual? team member can be improved by home BP monitoring with technological support, especially in small medical offices. The goal of this proposal is to evaluate whether our scalable SMS approach combined with a pharmacist-based intervention improves BP management cost effectively. To achieve this objective, we will determine if our intervention leads to decreases in BP; determine if our intervention leads to intensification of therapy; and determine the cost effectiveness of the intervention. At the end of this project, we expect to provide a novel, scalable and cost-effective approach for treating hypertension in rural populations by expanding the feasibility, scalability and dissemination of the Centralized Healthcare Solutions intervention. The intervention has important